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Open lung approach ...
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Ferrando, Carlos
(författare)
Open lung approach versus standard protective strategies Effects on driving pressure and ventilatory efficiency during anesthesia - A pilot, randomized controlled trial
- E-artikel/E-kapitelEngelska2017
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PUBLIC LIBRARY SCIENCE2017
Nummerbeteckningar
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LIBRIS-ID:21081235
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http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-326245uri
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urn:nbn:se:uu:diva-326245urn
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10.1371/journal.pone.0177399doi
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Background: Low tidal volume (VT) during anesthesia minimizes lung injury but may be associated to a decrease in functional lung volume impairing lung mechanics and efficiency. Lung recruitment (RM) can restore lung volume but this may critically depend on the post-RM selected PEEP. This study was a randomized, two parallel arm, open study whose primary outcome was to compare the effects on driving pressure of adding a RM to low-VT ventilation, with or without an individualized post-RM PEEP in patients without known previous lung disease during anesthesia. Methods: Consecutive patients scheduled for major abdominal surgery were submitted to low-VT ventilation (6 ml.kg(-1)) and standard PEEP of 5 cmH(2)O (pre-RM, n = 36). After 30 min estabilization all patients received a RM and were randomly allocated to either continue with the same PEEP (RM-5 group, n = 18) or to an individualized open-lung PEEP (OL-PEEP) (Open Lung Approach, OLA group, n = 18) defined as the level resulting in maximal Cdyn during a decremental PEEP trial. We compared the effects on driving pressure and lung efficiency measured by volumetric capnography. Results: OL-PEEP was found at 8 +/- 2 cmH(2)O. 36 patients were included in the final analysis. When compared with pre-RM, OLA resulted in a 22% increase in compliance and a 28% decrease in driving pressure when compared to pre-RM. These parameters did not improve in the RM-5. The trend of the DP was significantly different between the OLA and RM-5 groups (p = 0.002). VDalv/VTalv was significantly lower in the OLA group after the RM (p = 0.035). Conclusions: Lung recruitment applied during low-VT ventilation improves driving pressure and lung efficiency only when applied as an open-lung strategy with an individualized PEEP in patients without lung diseases undergoing major abdominal surgery.
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Biuppslag (personer, institutioner, konferenser, titlar ...)
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Suarez-Sipmann, Fernando
(författare)
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Tusman, Gerardo
(författare)
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Leon, Irene
(författare)
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Romero, Esther
(författare)
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Gracia, Estefania
(författare)
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Mugarra, Ana
(författare)
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Arocas, Blanca
(författare)
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Pozo, Natividad
(författare)
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Soro, Marina
(författare)
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Belda, Francisco J.
(författare)
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Uppsala universitetMedicinska och farmaceutiska vetenskapsområdet
(utgivare)
Sammanhörande titlar
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Del av/supplement till:channel record
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Ingår i:VärdpublikationPLoS ONE12:51932-6203
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Ferrando, Carlos
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Suarez-Sipmann, ...
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Tusman, Gerardo
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Leon, Irene
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Romero, Esther
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Gracia, Estefani ...
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Mugarra, Ana
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Arocas, Blanca
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Pozo, Natividad
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Soro, Marina
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Belda, Francisco ...
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